Provider Demographics
NPI:1730379843
Name:BURCHARD, ANDREW E (MD)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:E
Last Name:BURCHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2403
Mailing Address - Country:US
Mailing Address - Phone:401-274-2300
Mailing Address - Fax:401-272-1302
Practice Address - Street 1:118 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2403
Practice Address - Country:US
Practice Address - Phone:401-274-2300
Practice Address - Fax:401-272-1302
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13946207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1730379843Medicaid
RI1730379843Medicaid